Published Mar 26, 2026 | 7:00 AM ⚊ Updated Mar 26, 2026 | 7:00 AM
Fast food. (iStock)
Synopsis: A recent study found that Tamil Nadu, Karnataka, Telangana, Kerala and Andhra Pradesh are spending more of their food budget on fast food than anywhere else in India. The higher the fast-food spending, the higher the diabetes rate. And nowhere is that more visible than in the south.
It is 1 pm at a food court in Hyderabad’s Hitech City. The queues are long, the orders are familiar. Biryani, Kebab, and cold drinks. Around the tables sit software engineers, back-office workers, and delivery riders taking a break. Nobody is thinking about diabetes. Nobody ever is, until they have to be.
However, zoom out from this one food court to a dataset covering 18 Indian states, and a pattern emerges that is hard to ignore.
The five states most represented in food courts like this one, Tamil Nadu, Karnataka, Telangana, Kerala and Andhra Pradesh, are spending more of their food budget on fast food than anywhere else in India. And they are paying for it in a currency far more costly than rupees.
A study published in the Indian Journal of Medical Research has put numbers to what many public health researchers have long suspected. Tamil Nadu leads the fast-food spending table, accounting for 33.7 percent of its monthly per capita food budget to processed, packaged, and restaurant food.
Karnataka follows at 32.9 percent, then Telangana at 32.4 percent, Kerala at 28.4 percent and Andhra Pradesh at 28 percent.
In real money, that is ₹1,000 to ₹1,450 per person per month, every month, for fast food in these five states. In a country where the average urban monthly food spend is ₹4,120, nearly one-third of every food rupee in the south is being handed over to the fast-food industry.
The study, titled the Fast-food Attributed Diabetes Index Study or FADIS, analysed data from 18 states using two large national datasets. It found a strong and statistically significant correlation between fast-food expenditure and diabetes prevalence among urban men and urban women.
The higher the fast-food spending, the higher the diabetes rate. And nowhere is that more visible than in the south.
Urban Telangana men already have a diabetes prevalence of 3.8 percent. Kerala sits even higher, with rates of around four percent across both urban and rural populations. These are not alarming in isolation. But set against a population that is urbanising rapidly, eating out more, moving less and cooking at home far less often than a generation ago, they represent a trajectory that should worry policymakers deeply.
The study found that urban Indians spend about 25.9 percent of their food budget on fast food compared to 21.2 percent in rural areas. The gap between city and village is not just about access or convenience. It reflects a wholesale change in how urban India, and urban South India in particular, feeds itself.
The study describes this as India navigating a rapid nutritional shift from traditional, home-prepared diets to energy-dense, ultra-processed foods, driven by urbanisation, rising incomes, and changing work patterns such as longer working hours and dual-income households.
“What we are seeing in our clinics is the direct consequence of this shift,” Dr Vidya Tikoo, a Hyderabad-based endocrinologist, told South First. “Patients in their late thirties and early forties are presenting with type 2 diabetes that would have been unthinkable in their parents’ generation. The common thread almost always comes back to diet and sedentary urban living.”
The study does not treat this as a single story. For women, the picture is both different and more troubling.
While fast food spending correlates strongly with diabetes across urban populations, the study’s WEIGHT model found overweight prevalence to be the single strongest predictor of diabetes risk among women, statistically significant in both urban and rural settings. Fast food spending alone does not tell the full story for women. Weight does.
Among individuals with self-reported diabetes in the study, 63 percent were either overweight or obese. The proportion was higher among women, at 44 percent, compared to 34 percent among men.
In states like Punjab, Tamil Nadu and Andhra Pradesh, obesity rates among women considerably exceeded diabetes prevalence, pointing to a large at-risk population that has not yet been diagnosed.
The study specifically points to sociobiological vulnerabilities and systemic issues, including food marketing, caregiving roles, and lower physical activity levels in urban Indian women as factors compounding the risk. Urban southern women are carrying a double burden that the headline numbers alone do not fully capture.
Here is where the story gets complicated and more honest.
Kerala spends less on fast food than Tamil Nadu or Karnataka, at 28.4 percent of its food budget. Yet it records the highest diabetes prevalence in the study, at around four percent across both urban and rural populations. If fast food spending were the only variable, Kerala should not be at the top of this table.
The study itself acknowledges this complexity. It notes that underreporting of diabetes is more likely in rural areas due to limited access to diagnostic services, low health literacy, and delayed healthcare-seeking behaviour. Conversely, over-reporting may occur in urban regions where better awareness and increased screening lead to higher self-reported diagnoses.
In other words, Kerala’s numbers may look worse partly because Kerala screens more. A state that screens more will always find more. But that explanation only goes so far. Genetics, overall dietary patterns and deeply sedentary urban lifestyles are all part of Kerala’s story too.
“Kerala is a cautionary tale precisely because it is health-aware,” said Dr Iyer. “When you have a population that is educated, that goes to the doctor, that gets tested, you see the true burden of disease. The states that look better on paper may simply be undercounting.”
Ask any young professional in Hyderabad or Chennai how often they cook at home, and the answer is usually a rueful laugh. The economics of urban southern life have quietly dismantled the home kitchen.
When both partners work, when the commute is two hours each way, when Swiggy delivers in 20 minutes, the decision to cook is not a lifestyle choice. It is a luxury.
The study points directly to this dynamic, noting that increased access to convenience food outlets, sedentary lifestyles, and marketing exposure may be playing a more active role in diabetes risk in urban settings.
It also flags that in urban environments, accessibility to fast foods, defined as industrially prepared, energy-dense, ready-to-eat meals typically high in refined carbohydrates, added sugars, unhealthy fats, and sodium, has increased dramatically over the past two decades.
The authors of the FADIS study are careful about what their findings can and cannot claim. This is an ecological study, mapping correlations at the state level rather than proving causation at the individual level. The study itself cautions that factors such as self-reported diabetes data, changes in diet after diagnosis, and lack of individual-level behavioural data may influence the findings.
However, the population-level signal is clear enough to demand a response. “The findings highlight the importance of tailored public health strategies to address India’s evolving nutritional transitions and diabetes burden,” the authors noted. To address these challenges, they argue that “India must prioritise nutrition education campaigns, urban food policy reform, and community-level interventions targeted at high-risk populations.”
Gender-sensitive and region-specific strategies are specifically called for, given the particular vulnerability of urban women and the stark differences between high-spending southern states and the rest of the country.
(Edited by Muhammed Fazil.)
